Fillable NACP Renewal Upgrade PROV.-FINAL Dec 2016

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NACP Renewal Upgrade PROV.-FINAL Dec 2016

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National Advocate Credentialing Program
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION
SUBMISSION INSTRUCTIONS & REQUIREMENTS
This application is to be used by applicants who want to upgrade their PROVISIONAL credential.
While most applicants will upgrade to the next level - from PROVISIONAL to BASIC, the option to
upgrade from PROVISIONAL to INTERMEDIATE or PROVISIONAL to ADVANCED is available if
the applicant meets the required criteria. You should submit your application with the required
information detailed below.
You do
not
need to submit any pages which do not apply to or are not necessary
to meet the requirements for your requested status and specialty.
What you need to
provide for
Renewal/Upgrade
from:
PROVISIONAL
to
BASIC
PROVISIONAL
To
INTERMEDIATE
PROVISIONAL
to
ADVANCED
Documentation of
Hours of Experience:
3900 hours (2 years) of
verified experience
7800 hours (4 years) of
verified experience
15,600 hours (8 years) of
verified experience
Required Forms to
include with your
Application:
Certifications page signed by applicant (Page 10)
Three (3) Letters of Recommendation, which attest to your professional skills,
knowledge, and ability in the field and are relevant to the application for the NACP
Credential. Cannot be a general letter of reference for a job/position.
Memorandum of Confirmation – signed by someone with the authority to verify
employment and/or volunteer experience (See Page 14 for additional details.)
Client Contact Observation Form(s) - (See Page 11 for additional details.)
Required Continuing
Education:
32 hours required (in victim-assistance related topics and your Specialty area) for renewal
– verified by Certificate(s) of Completion OR Continuing Education Documentation
(CED) Form(s). See Page 3 for more details regarding documentation
You must declare
your Specialty
area(s)
See Page 1 for a list of the Service Specialty areas. You will use the list to make your
choice. If you serve three (3) or more of the target populations, you should choose
“Comprehensive Services Specialist”, which counts as one Specialty but will require
some training in at least three topic areas totaling a minimum of 20 hours.
Specialty training
required, which may
come entirely or in
part from your 32
Hours of Continuing
Education:
20 hours of “B” Level
Basic Training topics for
EACH area of Specialty.
20 hours of “B” Level Basic
Training topics and a
minimum of 10 hours of “C”
Level More Advanced
Training topics for EACH
area of Specialty.
20 hours of “B” Level Basic
Training topics and a
minimum of 20 hours of “C”
Level More Advanced
Training topics for EACH area
of Specialty.
When completed, include your non-refundable application fee (see page 2) and email, fax or mail your application
with supporting pages to: Email: credential@thenacp.org
Fax: 703-535-5500
Mailing address:
NACP Applications
National Organization for Victim Assistance
510 King Street, Suite 424
Alexandria, VA 22314
You will receive a confirmation receipt and status updates via email; therefore, be sure it is correct and legible on Page 1.
RENEWAL/UPGRADE from PROVISIONAL NACP APPLICATION – Revised December 2016 Page 1
National Advocate Credentialing Program
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION
You must:
1) document your 32 hours of continuing education in victim assistance-related topics.
2) attach a signed Certifications page,
3) attach Three (3) letters of Recommendation,
4) attach a Memorandum of Confirmation to verify any/all experience and
5) attach a signed Client Contact Observation Form(s) to verify your Specialty Area(s)
Finally, you must meet the minimum number of hours of verified experience and the minimum number of hours
BASIC
ADVOCATE
CREDENTIAL
•
A minimum of 3900 hours (2 years) verified experience;
•
A minimum of 20 hours of “B” Level Basic Specialty Training for
each
area of specialty, which may
come entirely or in part from your above-referenced 32 hours of continuing education
INTERMEDIATE
ADVOCATE
CREDENTIAL
•
A minimum of 7800 hours (4 years) verified experience;
•
A minimum of 20 hours of “B” Level Basic Specialty Training for
each
area of specialty, which may
come entirely or in part from your above-referenced 32 hours of continuing education.
•
A minimum of 10 hours of “C” Level More Advanced Specialty training for
each
area of specialty,
which may come entirely or in part from your above-referenced 32 hours of continuing education.
ADVANCED
ADVOCATE
CREDENTIAL
•
A minimum of 15,600 hours (8 years) verified experience;
•
A minimum of 20 hours of “B” Level Basic Specialty training for
each
area of specialty, which may
come entirely or in part from your above-referenced 32 hours of continuing education.
•
A minimum of 20 hours of “C” Level More Advanced Specialty training for
each
area of specialty,
which may come entirely or in part from your above-referenced 32 hours of continuing education.
Applications are
accepted from April 1 to April 30 and from October 1 to October 31. Approved applicants
will receive their certificates by mail within 8
-10 weeks
after
the end of each deadline period.
Contact Information
LAST NAME:
FIRST NAME, MI:
PREFERRED PHONE:
EMAIL ADDRESS:
PRIMARY MAILING
ADDRESS:
CURRRENT TITLE:
AGENCY/ORG. NAME:
COMPREHENSIVE SERVICES SPECIALIST
This option should be chosen when service providers work in criminal justice system-based programs or in full-service
community-based agencies SERVING THREE or MORE of the below-listed target populations.
CHILD ABUSE SPECIALIST DOMESTIC VIOLENCE SPECIALIST
DRUNK DRIVING SPECIALIST SEXUAL ASSAULT SPECIALIST
HOMICIDE SPECIALIST CAMPUS ADVOCACY SPECIALIST
PROGRAM MANAGEMENT SPECIALIST
RENEWAL/UPGRADE from PROVISIONAL NACP APPLICATION – Revised December 2016 Page 2
National Advocate Credentialing Program
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION
PAYMENT INFORMATION
Credit Card information will be shredded after processing.
NACP DISCLAIMER FOR ALL LEVELS OF CREDENTIALING
• NACP, as a voluntary, national credentialing body for advocates and providers of crime victim services,
makes every effort to ensure that applicants meet the minimum standards for experience, whether paid or
volunteer, as well as required introductory training and continuing education to attain the Basic, Intermediate
or Advanced advocate credential.
• NACP makes every effort to ensure that applicants for Basic, Intermediate or Advanced credential offer a
good faith representation of victim service experience and advocacy through the application questionnaire,
observation evaluations from colleagues, letters of support and follow-up contact.
• NACP has no educational, legal, statutory, regulatory or investigative authority to ensure that applicants are
qualified or competent to provide services to crime victims.
• NACP cannot ensure the accuracy of the information provided by the applicant. NACP reserves the right to
make changes in the application requirements and process at any time and without notice.
•
NACP reserves the right to review, suspend or revoke any credential based upon alleged and/or confirmed
violations of the Code of Professional Ethics for Victim Assistance Providers.
Payment and Fee Information
Credentialing Fee (non-refundable): $140.00
_______ I qualify for the Military Discount.
($110.00)
(Initial Here)
PAYMENT TERMS:
Returned checks, declined money orders, or declined credit card transactions are subject to an
additional $25.00 fee.
If you are submitting credit card information, please be sure the billing address indicated below
is the correct billing address on file with the card issuing bank.
An incorrect billing address will result in an additional
$5.00 fee being applied per submission attempt.
PAYMENT FORM:
Check One:
Check Payable to “NOVA”
Money Order Payable to “NOVA”
Visa/MasterCard/American Express (complete section below)
Credit Card
NAME ON CREDIT CARD
CREDIT CARD NUMBER
EXPIRATION DATE:
BILLING ADDRESS
ON FILE WITH
ISSUING BANK:
__________________________________________________________
__________________________________________________________
*Military Exception: Fee = $110.00 In honor of your service to the United States Military, NACP
provides an application fee discount to all Active Duty members, Reserves, Veterans, Retirees or DOD
Contract/Civilian Employees. [Please Note: If you are a D-SAACP-credentialed advocate seeking an
NACP credential, please use the Bridge Application. Questions? Contact dsaacp@trynova.org].
Include the application fee of $140.00*.
Payment may be made by submitting a
check payable to NOVA
(included with your application)
or by
completing the credit card section below
.
RENEWAL/UPGRADE from PROVISIONAL NACP APPLICATION – Revised December 2016 Page 3
National Advocate Credentialing Program
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION
NACP APPLICANT CONTINUING EDUCATION/SPECIALTY TRAINING INFORMATION
Use this page to summarize the continuing education training you received from the date of your last credential.
You must also attach copies of your Certificates of Completion OR signed NACP Continuing Education
Documentation (CED) Forms
for all trainings. (Additional CED Forms may be downloaded at
www.theNACP.org
).
Certificates of Completion must include title of training, date(s) and number of hours.
If
you have a Certificate of Completion with all required information, a CED Form is not required. If you
participated in a webinar, your email confirmation
of attendance
(after
the webinar) with
all
the required
details is acceptable.
A minimum of 32 hours of continuing education is required every 2 years and must be completed after the
credentialing application/renewal submission month and before the end of the two-year month deadline.
Reminder
:
As a current Provisional credentialed applicant upgrading to Basic, Intermediate or
Advanced credential
, your 32 hours of continuing education
should include entirely or in part,
the
required number of hours of training for your Specialty area(s) based upon the level of Credential (BASIC,
INTERMEDIATE OR ADVANCE)
to which you are upgrading. Specialty training should also be
documented under your declared Specialty area(s) found on pp. 4-8 with Certificates of Completion
OR NACP CED form(s) attached.
Specialty Area(s): ____________________
______________________
Date(s)
Total
Hours
Hours
toward
Specialty
Area(s)
____ Certificate or
____ CED Form
Example: Name of Training/Sponsor of Training
"Prosecution of DV & SA Cases Involving
Strangulation"
/
Greene County DV Shelter
11/1/16
4 4
_____ Certificate or
__X__ CED Form
____ Certificate or
_ __ CED Form
____ Certificate or
____ CED Form
____ Certificate or
____ CED Form
____ Certificate or
____ CED Form
____ Certificate or
____ CED Form
____ Certificate or
____ CED Form
____ Certificate or
____ CED Form
____ Certificate or
____ CED Form
____ Certificate or
____ CED Form
____ Certificate or
____ CED Form
____ Certificate or
____ CED Form
Total Number of Hours
RENEWAL/UPGRADE from PROVISIONAL NACP APPLICATION – Revised December 2016 Page 4
National Advocate Credentialing Program
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION
“B” Level and “C” Level Specialty Training Hours Documentation
“B” Level Specialty Training includes, but is not limited to, topics that are basic to the Specialty population served.
“C” Level Specialty Training includes topics, which are more advanced topics to the Specialty population served.
Document your required Specialty Training hours under your Specialty area(s) & requested Credential Level below
with Certificates of Completion OR NACP CED form(s) attached
.
COMPREHENSIVE SPECIALTY
BASIC NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for BASIC Credential: ______ (min. 20 hours)
Record some amount of training hours in at least three of the following Specialty areas for a minimum of 20
hours total: Domestic Violence_____ Sexual Assault______ Child Abuse_____ Drunk Driving______
Homicide_____ Campus Advocacy_____ Program Management______ General Victim Services_____
INTERMEDIATE NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (min. 20
hours)
Record some amount of training hours in at least three of the following Specialty areas for a minimum of 20
hours total: Domestic Violence_____ Sexual Assault______ Child Abuse_____ Drunk Driving______
Homicide_____ Campus Advocacy_____ Program Management______ General Victim Services_____
Number of “C” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (min. 10
hours)
Record some amount of training hours in at least three of the following Specialty areas for a minimum of 10
hours total: Domestic Violence_____ Sexual Assault______ Child Abuse_____ Drunk Driving______
Homicide_____ Campus Advocacy_____ Program Management______ General Victim Services_____
ADVANCED NACP Credential Applicant:
Number of “B” Level Specialty Training Hours required for ADVANCED Credential: _____ (min. 20 hours)
Record some amount of training hours in at least three of the following Specialty areas for a minimum of 20
hours total: Domestic Violence_____ Sexual Assault______ Child Abuse_____ Drunk Driving______
Homicide_____ Campus Advocacy_____ Program Management______ General Victim Services_____
Number of “C” Level Specialty Training Hours required for ADVANCED Credential: _____ (min. 20 hours)
Record some amount of training hours in at least three of the following Specialty areas for a minimum of 20
hours total: Domestic Violence_____ Sexual Assault______ Child Abuse_____ Drunk Driving______
Homicide_____ Campus Advocacy_____ Program Management______ General Victim Services_____
RENEWAL/UPGRADE from PROVISIONAL NACP APPLICATION – Revised December 2016 Page 5
National Advocate Credentialing Program
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION
“B” Level and “C” Level Specialty Training Topics and Documentation
“B” Level Specialty Training includes, but is not limited to, topics that are basic to the Specialty population
served. “C” Level Specialty Training includes topics, which are more advanced topics to the Specialty
population served. Document your required Specialty training hours under your Specialty area(s) & requested
Credential Level below with Certificates of Completion OR NACP CED form(s) attached
.
DOMESTIC VIOLENCE SPECIALTY TOPICS
“B” Level Specialty Training Topics
“C” Level Specialty Training Topics
Includes: Barriers to Safety, Batterers’ Use of Power & Control;
Child Abuse & Neglect; Lesbian & Gay Battering;
Lethality/Danger Assessment; Domestic Violence Statutes;
Protection Orders; Safety Planning; Trauma Informed
Approaches; Dynamics of Victimization; Systems Advocacy;
State/Federal Statutes
Includes: Strangulation; Vicarious Trauma; Post-Conviction
Systems; Related Statutes (Agg. Menacing; Crim. Trespassing;
Stalking; Protection Orders; Viol.; Child Abuse); AAaC/ACoA;
Ritual Abuse; Topics from Sexual Assault Basic Training Areas;
Suicide Intervention; Support Groups; Human Trafficking; Social
Media; Protective Order Enforcement; Underserved Populations;
Systems Advocacy; Victim Impact Statements; Victims who Resort
to Violence; Cyber Stalking; ID Theft and New Developments in
the Field
DOMESTIC VIOLENCE Specialty Training Documentation
BASIC NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for BASIC Credential: _____ (minimum 20 hours)
INTERMEDIATE NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (minimum 20 hours)
Number of “C” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (minimum 10 hours)
ADVANCED NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for ADVANCED Credential: _____ (minimum 20 hours)
Number of “C” Level Specialty Training Hours required for ADVANCED Credential: _____ (minimum 20 hours)
SEXUAL ASSAULT (Adult/Child) TOPICS
“B” Level Specialty Training Topics
“C” Level Specialty Training Topics
Includes: Sexual Assault/Abuse, HIV-STD Information,
Interviewing Victims/Survivors, Sexual Offense Statutes, Police
Investigation of Rape, Rape Evidence Examination, Rape
Trauma Syndrome, Trauma-Informed Care, DNA Evidence,
Special Population, Human Trafficking
Includes: more of the types of subjects listed in this category in the
Basic training area; but at a more advanced level. Cyberstalking;
DNA Cold-Case Testing; Sexting and other Social Media Issues;
and other emerging topics relevant to advocates and managers of
these types of programs
SEXUAL ASSAULT Specialty Training Documentation
BASIC NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for BASIC Credential: _____ (minimum 20 hours)
INTERMEDIATE NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (minimum 20 hours)
Number of “C” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (minimum 10 hours)
ADVANCED NACP Credential Applic ant
Number of “B” Level Specialty Training Hours required for ADVANCED Credential: _____ (minimum 20 hours)
Number of “C” Level Specialty Training Hours required for ADVANCED Credential: _____
(minimum 20 hours)
RENEWAL/UPGRADE from PROVISIONAL NACP APPLICATION – Revised December 2016 Page 6
National Advocate Credentialing Program
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION
“B” Level and “C” Level Specialty Training Topics and Documentation
“B” Level Specialty Training includes, but is not limited to, topics that are basic to the Specialty population
served. “C” Level Specialty Training includes topics which are more advanced topics to the Specialty
population served. Document your required Specialty training hours under your Specialty area(s) & requested
Credential Level below with Certificates of Completion OR NACP CED form(s) attached.
CHILD ABUSE TOPICS
“B” Level Specialty Training Topics
“C” Level Specialty Training Topics
Includes: Child Physical Abuse/Maltreatment/Neglect;
Parental & Non-Parental Child Abduction; All Crimes
Against Children; Forensic Interviewing/Serving Child
Victims; Multi-disciplinary Approaches to Working with
Child Victims of Crime; Child Safety/Protection; Trauma-
Informed Care; Human Trafficking
Includes: more of the types of subjects listed in this category
in the Basic Training Specialty Areas, but at a more
advanced level. Also, includes emerging issues and topics
relevant to advocates and managers of these types of
programs
CHILD ABUSE Specialty Training Documentation
BASIC NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for BASIC Credential: _____ (minimum 20 hours)
INTERMEDIATE NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (minimum 20 hours)
Number of “C” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (minimum 10 hours)
ADVANCED NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for ADVANCED Credential: _____ (minimum 20 hours)
Number of “C” Level Specialty Training Hours required for ADVANCED Credential: _____ (minimum 20 hours)
DRUNK DRIVING TOPICS
“B” Level Specialty Training Topics
“C” Level Specialty Training Topics
Includes: Advocacy with Police; Prosecutors, Judiciary,
Probation and Parole, Basics of CJS, Aftermath of Drunk
Driving, Assessment for PTSD, other counseling needs,
Catastrophic Injury Experience, Drunk Driving Impact Panels,
Homicide Survivor Experience, Insurance/Civil
Suits/Bankruptcy, Applicable State Statutes
Includes: Adult Siblings, Children’s Grief Process, Complicated
Mourning; Crisis Response; Death Notification; Male Grief;
PTSD; Rehabilitation; Support for Advocates; Support Groups;
Survivor Issues; Vicarious Victimization; MADD Victim
Institutes; New State/Federal Statutes; New Developments in the
Field
DRUNK DRIVING Specialty Training Documentation
BASIC NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for BASIC Credential: _____ (minimum 20 hours
INTERMEDIATE NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (minimum 20 hours)
Number of “C” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (minimum 10 hours)
ADVANCED NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for ADVANCED Credential: _____ (minimum 20 hours)
Number of “C” Level Specialty Training Hours required for ADVANCED Credential: _____ (minimum 20 hours)
RENEWAL/UPGRADE from PROVISIONAL NACP APPLICATION – Revised December 2016 Page 7
National Advocate Credentialing Program
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION
“B” Level and “C” Level Specialty Training Topics and Documentation
“B” Level Specialty Training includes, but is not limited to, topics that are basic to the Specialty population
served. “C” Level Specialty Training includes topics, which are more advanced topics to the Specialty
population served. Document your required Specialty training hours under your Specialty area(s) & requested
Credential Level below with Certificates of Completion OR NACP CED form(s) attached
.
HOMICIDE TOPICS
“B” Level Specialty Training Topics
“C” Level Specialty Training Topics
Includes: Interventions with Homicide Survivors; Grief Process;
Dealing with Law Enforcement; Dealing with Medical Services;
Death Notification; Medical Examiners; Coroner’s Office
Procedures/Protocol Applicable State Statutes; Trauma-
Informed Care; Crime Victim Compensation; Funeral Homes
and costs; Funeral Directors/ Protocol, Intervention with Child
Victims, Referral to appropriate support groups.
Includes: Dealing with Holidays & Special Occasions; Dealing
with the Parole Board; Working with Faith-Based
Communities, Realities of Capital Murder Cases, Support
Groups, Truth In Sentencing, New State/ Federal Statutes, New
Developments in the Field, Trauma-Informed Care, Working
with Cold Case Survivors, basic understanding of DNA,
Working with Victims/Survivors and the Media, Mass
Victimization. Working with prisons victim services.
HOMICIDE Specialty Training Documentation
BASIC NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for BASIC Credential: _____ (minimum 20 hours)
INTERMEDIATE NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (minimum 20 hours)
Number of “C” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (minimum 10 hours)
ADVANCED NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for ADVANCED Credential: _____ (minimum 20 hours)
Number of “C” Level Specialty Training Hours required for ADVANCED Credential: _____ (minimum 20 hours)
CAMPUS ADVOCACY TOPICS
“B” Level Specialty Training Topics
“C” Level Specialty Training Topics
Includes: History of the Student Movement regarding Sexual
Assault on College Campus, Federal & State Campus
Legislation (Title IX, Cleary Act and FERPA) and Victims’
Rights, Sexual Assault/Rape Culture, Campus Safety Planning,
Trauma-Informed Advocacy, Sexual Violence and Substance
Abuse, Safety Planning and Protective Orders, Ethics,
Boundaries and Confidentiality.
Includes: Community Partnerships, Outreach and
Empowerment of Marginalized Students, Supporting student
survivors with disabilities, Evidence-based strategies for
primary prevention, Bystander intervention, Risk Reduction
Programs, Neurobiology of Trauma; Trauma-Informed
Interview Techniques; Cultural Awareness and Sexual
Violence; Sexual Assault Perpetrator Behavior; Managing
written records and data collection requirements.
CAMPUS ADVOCACY Specialty Training Documentation
BASIC NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for BASIC Credential: _____ (minimum 20 hours)
INTERMEDIATE NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (minimum 20 hours)
Number of “C” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (minimum 10 hours)
ADVANCED NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for ADVANCED Credential: _____ (minimum 20 hours)
Number of “C” Level Specialty Training Hours required for ADVANCED Credential: _____ (minimum 20 hours)
RENEWAL/UPGRADE from PROVISIONAL NACP APPLICATION – Revised December 2016 Page 8
National Advocate Credentialing Program
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION
“B” Level and “C” Level Specialty Training Topics and Documentation
“B” Level Specialty Training includes, but is not limited to, topics that are basic to the Specialty population
served. “C” Level Specialty Training includes topics, which are more advanced topics to the Specialty
population served. Document your required Specialty training hours under your Specialty area (s) & requested
Credential Level below with Certificates of Completion OR NACP CED form(s) attached
.
PROGRAM MANAGEMENT TOPICS
“B” Level Specialty Training Topics
“C” Level Specialty Training Topics
Includes: Community Needs Assessment; Program
Development; Community Relations; Personnel
Management; Coordinated Services; General
Administration; Fiscal Management; Proposal Writing;
Grants Management; Budgeting; Record Keeping;
Volunteer Management; Supervision; Labor Laws; Other
Program Management Topics.
Includes: Service Evaluation; Legislation; Board
Development; Developing & Maintaining Task Forces;
Research; Expert Testimony; Protocols; Fund Raising;
Public Speaking; Public Policy Issues; Policy
Development; Relationship Development with Board
Members; Government Officials and Colleagues;
Training Techniques and Advanced Victim Assistance
Program Management Topics
PROGRAM MANAGEMENT Specialty Training Documentation
BASIC NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for BASIC Credential: _____ (minimum 20 hours)
INTERMEDIATE NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (minimum 20 hours)
Number of “C” Level Specialty Training Hours required for INTERMEDIATE Credential: _____ (minimum 10 hours)
ADVANCED NACP Credential Applicant
Number of “B” Level Specialty Training Hours required for ADVANCED Credential: _____ (minimum 20 hours)
Number of “C” Level Specialty Training Hours required for ADVANCED Credential: _____ (minimum 20 hours)
ADD’L GENERAL VICTIM SERVICES TRAINING TOPICS
“B” Level Topics
“C” Level Topics
Includes: Community Resources; Court Advocacy;
Hospital Advocacy; Applicable
State Statutes; Specialized
Needs; Trauma of Victimization; Trial Preparation;
Victims’ Rights Legislation/Statutes; Restorative Justice;
Victim/Offender Reconciliation; Victim/Offender
Mediation; Hate Crimes; Identity Theft
Includes: Includes: Burglary/Robbery Victims; Topics
from Basic and Advanced Specialty Areas (Domestic
Violence; Adult and/or Child Sexual Assault; Child
Abuse; Drunk Driving; General System or Community-
Based Services; Homicide) Legal Precedents; Testimony
Issues; Crimes against LGBT Community; New
State/Federal Statutes; New Developments in the Field
ADD’L GENERAL VICTIM SERVICES TRAINING DOCUMENATION
This space may be used by all applicants to document any additional training regardless of specialty area.
Number of “B” Level Specialty Training Hours: _____ Number of “C” Level Specialty Training Hours: _____
RENEWAL/UPGRADE from PROVISIONAL NACP APPLICATION – Revised December 2016 Page 9
National Advocate Credentialing Program
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION
CERTIFICATIONS
Read each of the following statements and initial where appropriate:
_______ I, the undersigned applicant, hereby certify that I have never been convicted of any crime stemming
from an act of violence or threat thereof, any felony, or any criminal act with respect to a child.
(Attach explanation for any convictions)
_______ I, the undersigned applicant, hereby certify that I have read and agree to continue following the attached
Code of Professional Ethics for Victim Assistance Providers.
_______ I, the undersigned applicant, hereby certify that I have never been terminated from a volunteer or paid
position due to conduct that is in violation of the Code of Professional Ethics for Victim Assistance Providers.
_______
[Military Exception Only]
I, the undersigned applicant, hereby certify that I qualify for the Military
Discount.
_______ I, the undersigned applicant, hereby certify that I agree to the nonrefundable NACP payment terms and
fees listed in the “Payment and Fee Information” section of this document.
_______ I, the undersigned applicant, hereby certify that I have read and understand the NACP Disclaimer.
______ I, the undersigned applicant, hereby authorize NOVA staff to contact any former employers to
verify my past work, volunteer or internship experience.
______
I, the undersigned applicant, hereby certify that I understand, if approved, my credential is valid until
the expiration date listed on my certificate/card; and, during the next two years I must seek 32 hours of
continuing education relevant to victim assistance and my Specialty area(s) which will be required when I
choose to upgrade my credential.
Please ensure this section is signed and dated.
Under 28 U.S. Code s. 1746, I certify under penalty of perjury that the above initialed Certifications are true
and correct.
I further certify that the information reported on any enclosures is true and accurate.
Signature_______________________________________________ Date____________________________
Name_____________________________________________ Title_______________________________
Phone Number___________________________________________
Email__________________________________________________
RENEWAL/UPGRADE from PROVISIONAL NACP APPLICATION – Revised December 2016 Page 10
National Advocate Credentialing Program
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION
CLIENT CONTACT OBSERVATION FORM
[APPLICANT: PLEASE CHECK SPECIALTY POPULATION(S) BELOW]
This form must be completed by a person who can evaluate the applicant’s interactions with and
services to those victimized by crime.
Pease read and follow these instructions:
• Person completing this form
must have observed
the applicant’s interactions and work performance as
it relates to the provision of services by the advocate to those victimized by crime.
• The Client Contact Observation Form must be returned to the applicant for inclusion in the NACP
application package.
This applicant has declared a specialty in the area(s) marked below:
____ COMPREHENSIVE SERVICES
(
Working in three (3) or more of the below-listed Specialty Areas
)
____ CHILD ABUSE
____ DOMESTIC VIOLENCE
____ DRUNK DRIVING
____ HOMICIDE
____ SEXUAL ASSAULT
____ CAMPUS ADVOCACY
____ PROGRAM MANAGEMENT
Of those checked above, do you believe the applicant’s training, skills, abilities and knowledge adequately
prepares her/him to be considered a specialist in providing service to the population(s) selected?
____ Yes ____ No
Please provide some specific points and comments to support your answer:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
RENEWAL/UPGRADE from PROVISIONAL NACP APPLICATION – Revised December 2016 Page 11
National Advocate Credentialing Program
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION
CLIENT CONTACT OBSERVATION FORM
CLIENT CONTACT OBSERVATION FORM
Based upon your observations of the applicant’s interactions, please answer the following
questions by circling yes or no and adding comments, if any, below each question.
1.
Was the applicant knowledgeable about the services, system, etc. and able to
convey information accurately to the client?
YES NO
2.
Was the applicant able to use listening skills to ascertain the client’s
needs?
YES NO
3.
Was the applicant sensitive to the client’s needs and concerns and able to
convey that to the client?
YES NO
4.
Was the applicant able to provide the client with viable options that
addressed the client’s identified needs and concerns?
YES NO
5.
Was the applicant able to address questions the client posed and provide
accurate answers or to obtain the answers if the advocate was unable to
answer them?
YES NO
6.
Was the applicant able to provide timely case status information to the
client in order to keep the client informed as the case progressed through the
system, if applicable?
YES NO N/A
7.
Was the applicant able to document client contacts in a timely, objective
manner?
YES NO
8.
Was the applicant able to remain objective and professional
throughout the interaction?
YES NO
9.
Was the applicant able to remain calm and professional if conflict arose
with the client?
YES NO
RENEWAL/UPGRADE from PROVISIONAL NACP APPLICATION – Revised December 2016 Page 12
National Advocate Credentialing Program
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION
CLIENT CONTACT
OBSERVATION (CONTINUED)
10.
Was the applicant able to advocate in behalf of the client with other professionals? YES NO
(prosecutors, judges, service providers, etc.)
11.
Was the applicant able to remain calm and professional if conflict arose with other YES NO
professionals?
12.
If you have any additional comments about the interventions that you observed, please explain here:
SUMMARY QUESTIONS
In summary, please answer this final question and add any additional comments.
Based upon your opinion, do the applicant’s demonstrated skills and abilities qualify him or her for NACP
credentialing? YES _____ NO _____
Please include an explanation below
.
NACP welcomes any additional comments you have about the applicant:
I have completed the above observation form and will return it to the applicant for inclusion in the NACP
application packet.
OBSERVER’S NAME: ____________________________________ __________________
Print Name Date
SIGNATURE:
RENEWAL/UPGRADE from PROVISIONAL NACP APPLICATION – Revised December 2016 Page 13
National Advocate Credentialing Program
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION
INSTRUCTIONS for
MEMORANDUM OF CONFIRMATION (M.O.C.)
VERIFICATION OF EXPERIENCE WORKING WITH THOSE VICTIMIZED BY CRIME
• Experience: The Memorandum of Confirmation (M.O.C.) must be completed and signed by someone
in a position of authority to ver
ify your employment, volunteer, internship or practicum
experience
, and returned to you for inclusion in your application packet. Make copies of the form as
needed.
NOTE: You should only provide documentation for the experience necessary to meet the hours
required for the credentialing level for which you are applying. Documentation of ALL prior relevant
experience may not be necessary.
Use Template on Next Page: The form on the next page provides a template that should be copied onto
the letterhead of the agency where the applicant worked as an employee, volunteer, intern, etc. The
person authorized to verify the applicant’s work with the agency should fill out the information in the
box and sign where appropriate.
• Full-time Defined: The maximum credit for one year of service is based upon a 40-hour work week
and equal to 2080 hours per year. Some positions are considered full-time with fewer hours per week;
use the actual hours worked or volunteered per week (up to a maximum of 40 hours) when completing
this form.
• On-Call Hours: As a Full-Time employee, you can claim
actual hours but cannot claim additional
hours if you also provide “on-call” services as part of your position. For the Applicant who provides “on-
call” (24/7) services independent of or in addition to Part-time Employment or as a function of a Volunteer/Other
Position, the maximum credit allowed is ACTUAL TIME – hours per week – up to a maximum of 1950 hours per
year. Finally, if you only provide 24/7 “on call” services, the maximum credit given during a 12-month
period will be 1950 hours.
• Partial Victim Services Responsibilities: If you provide services to those victimized by crime as all or
part of your responsibilities through an agency/organization (e.g., in a counseling center
or hospital
emergency department) whose services are not exclusively for crime victims, you may only reflect the
hours (or percentage of your time) spent providing direct services to those victimized by crime.
• Computation of Hours of Experience: For best accuracy, please follow these instructions to determine
the total number of hours for each experience you have had working with those victimized by crime:
o Go to: http://www.convertunits.com/dates/
o Enter the dates you have worked (From-To) and press GO;
o Under the “Date Difference From-To” section, look for the total number of weeks (6th paragraph)
Multiply the number of weeks by the number of hours worked per week, which cannot exceed 40
hours per week.
• Past Experience: The Exception to the Memorandum of Confirmation
form should only be used to
verify applicant’s experience working with those victimized by crime when records are no longer
available or an agency no longer exists.
NATIONAL ADVOCATE CREDENTIALING PROGRAM (NACP)
MEMORANDUM OF CONFIRMATION (M.O.C.) TEMPLATE
This M.O.C. must be completed by a person authorized to verify the applicant’s
employment, volunteer, or internship/practicum experience
(Please refer to pg. 16 for additional instructions).
THE BOX BELOW MUST BE PRINTED ON AGENCY LETTERHEAD.
I, _______________________ certify that the applicant ____________________
(Your Name) (Name of Applicant)
provided direct services (to those victimized by crime) in the capacity of
_________________________ at ____________________________________
(Position Title) (Name of Agency)
The Applicant provides/provided these services from:
Start date:
___/___/___ to:
CURRENT
_____
OR End date
___/____/____
and works/worked
_____ hours per week
as a
(Check one) F
ull-time ____ Part-time _____
(Check one) Employee _____
Volunteer _____ Other _______________________
(Please specify)
Total number of hours worked in this position: ______________
Confirmation:
I am the person authorized to verify the applicant’s employment, volunteer or
internship/practicum experience. Under 28 U.S. Code s. 1746, I certify under
penalty of perjury that the attached Memorandum of Confirmation
is true
and correct.
Signature____________________________ Date____________________________
Name__________________________________, Title_______________________________
Phone Number Email
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION – Revised December 2016
National Advocate Credentialing Program
RENEWAL/UPGRADE from PROVISIONAL to a higher level NACP APPLICATION
MOC (Memorandum of Confirmation) EXCEPTION
THIS FORM SHOULD ONLY BE USED TO VERIFY APPLICANT’S PAST
EXPERIENCE WORKING
WITH THOSE VICTIMIZED BY CRIME
WHEN RECORDS ARE NO LONGER AVAILABLE
OR AN AGENCY NO LONGER EXISTS. MUST BE COMPLETED BY CURRENT SUPERVISOR.
Experience may include employment, volunteer or internship/practicum.
Applicant’s Name: ______________________________________________
Position Applicant Held: _________________________________________
Employee: _____ Volunteer: _____ Other: (Specify) ___________________________
Information about Agency, Supervisor and Position
Dates of
Service
# hours per week
(specify)
Name of Agency:
_____________________________________________
Agency Address: ______________________________
_____________________________________________
Agency Phone: ________________________________
Supervisor’s Name:
___________________________________________
From:
___/____/_____
T
o:
____/____/_____
_____ hrs. per week
Total Hours: _________
F
or best accuracy,
please visit
www.convertunits.com
Additional Comments:
T
otal Hours: ___________
Current Supervisor:
Under
28 U.S. Code $1746 I certify under penalty of perjury that the foregoing is true and correct
.
Executed on __________________________________________.
I have reviewed this form with the applicant and verify its contents to the best of my ability.
Print Name: ___________________________________________ Title: ___________________________________
S
ignature: ____________________________________________________ Date: ___________________________
S
upervisor Contact Information:
P
hone Number: ______________________________________________________________________
E
mail: ________________________________________________________________________
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